Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications

Abstract

Background: Most children who have congenital heart disease in low-and middle-income countries (LMICs), including Uzbekistan, do not receive adequate and timely pediatric cardiac surgical care. To strengthen the surgical capacity of a local pediatric cardiac surgery team in Tashkent, Uzbekistan, the JW LEE Center for Global Medicine at Seoul National University College of Medicine has developed a team-based training program and has been collaboratively conducting surgeries and care in order to transfer on-site knowledge and skills from 2009 to 2019. Objectives: To evaluate the long-term effects of the collaborative program on the cardiac surgical capacity of medical staff (teamwork, surgical complexity, and patients' pre-surgical weights) as well as changes in the lives of the patients and their families. To derive lessons and challenges for other pediatric cardiac surgical programs in LMICs. Methods: To assess the effects of this ten-year long program, a mixed-methods design was developed to examine the trend of surgical complexity measured by Risk Adjustment for Congenital Heart Surgery 1 score (RACHS-1) and patients' pre-surgical weights via medical record review (surgical cases: n = 107) during the decade. Qualitative data was analyzed from in-depth interviews (n = 31) with Uzbek and Korean medical staff (n = 10; n = 4) and caregivers (n = 17). Findings: During the decade, the average RACHS-1 of the cases increased from 1.9 in 2010 to 2.78 in 2019. The average weight of patients decreased by 2.8 kg from 13 kg to 10.2 kg during the decade. Qualitative findings show that the surgical capacity, as well as attitudes toward patients and colleagues of the Uzbek medical staff, improved through the effective collaboration between the Uzbek and Korean teams. Changes in the lives of patients and their families were also found following successful surgery. Conclusions: Team-based training of the workforce in Uzbekistan was effective in improving the surgical skills, teamwork, and attitudes of medical staff, in addition, a positive impact on the life of patients and their families was demonstrated. It can be an effective solution to facilitate improvements in pediatric cardiovascular disease in LMICs if training is sustained over a long period.

Cardiac Surgery and Interventional Cardiology Capacity Development: Insights from Ethiopia and Côte d’Ivoire

“…According to the 10-year teambased collaborative capacity collaborative capacity building program evaluation from 2010 to 2019, the average Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) score increased from 1.9 to 2.78, while the average preoperative weight of patients decreased by 2.8 kg, from 13 kg (2009) to 10.2 kg (2019). In-depth interviews with Uzbek and Korean medical staff, patients, and caregivers show an improvement in Uzbek medical personnel's surgical capacity, an improvement in attitudes toward patients and colleagues, and changes in the quality of life of patients and caregivers [26]. Based on these findings in Uzbekistan, a teambased program proved to be effective as a program to strengthen the pediatric cardiovascular disease treatment capacity in low-and middle-income countries (Fig.…”

The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed‐methods approach

“…Mongolian trainees and Korean trainers perform their clinical duties together or in parallel, depending on what is considered more efficient. More details on the training can be found elsewhere 9,46 …”

“…Increasing the quality of teamwork within a cohesive multidisciplinary surgical team is known to result in successful patient and surgical outcomes 5‐8 . A team is defined as ‘two or more individuals with specific tasks working together to achieve common goals through sharing information, resources, and mutual trust’ 9 . Promoting effective teamwork among local medical staff has been shown to improve surgical outcomes for children with CHD in LMICs 9 .…”

Establishing Surgical Care Sustainability in Sub-Saharan Africa for Global Child Health: Insights From Pediatric Cardiac Surgical Capacity-Building Programs in Ethiopia and Côte d'Ivoire

“…Individuals benefit from the team-based program; these include medical staff, as well as patients and caregivers. According to the 10-year team-based collaborative capacity-building program evaluation from 2010 to 2019, the average Risk Adjustment for Congenital Heart Surgery 1 score increased from 1.9 to 2.78, while the average preoperative weight of patients decreased by 2.8 kg from 13 kg in 2009 to 10.2 kg in 2019 (7). In-depth interviews with Uzbek and Korean medical staff, patients, and caregivers showed an improvement in the surgical capacity of Uzbek medical personnel, an improvement in attitudes toward patients and colleagues, and changes in the quality of life of patients and caregivers (7).…”

“…According to the 10-year team-based collaborative capacity-building program evaluation from 2010 to 2019, the average Risk Adjustment for Congenital Heart Surgery 1 score increased from 1.9 to 2.78, while the average preoperative weight of patients decreased by 2.8 kg from 13 kg in 2009 to 10.2 kg in 2019 (7). In-depth interviews with Uzbek and Korean medical staff, patients, and caregivers showed an improvement in the surgical capacity of Uzbek medical personnel, an improvement in attitudes toward patients and colleagues, and changes in the quality of life of patients and caregivers (7). Based on these findings in Uzbekistan, the team-based program proved to be effective at strengthening the pediatric cardiovascular disease treatment capacity of lowand middle-income countries (8).…”